Long COVID Update

When people started contracting and recovering from COVID, many were surprised and disturbed to learn that symptoms linger in anywhere from 10 – 30 percent of people who get the disease, even after they recover from the initial infection and test negative.  The syndrome is called long COVID, post COVID, post-acute COVID syndrome, or “long haulers.” Since that time, doctors and scientists have learned a lot about it and are working to develop treatments that could help.

• There are three types of long COVID. The first one relates to the virus’s having damaged cells in ways that cause lingering symptoms. COVID affects all of the body’s systems, so symptoms vary. Those with damage to the heart may experience palpitations, while those with lung damage would likely experience shortness of breath. Digestive upset, rashes, and hair loss can also be associated with COVID damage.
• The second cause of long COVID relates to prolonged hospital care. Symptoms—like muscle weakness, cognitive brain dysfunction, and a post-traumatic stress disorder-like syndrome—sometimes arise after a patient has been in the hospital for a long time. 
• Finally, symptoms can be caused by overactive immune or inflammatory systems. This is the most complex of the three types, and doctors are still working to understand it. Symptoms in this grouping vary but can include anxiety, depression, insomnia, and cognitive dysfunction or brain fog.
• Those who received care in the ICU are most likely to experience long COVID.  Interestingly, studies have found that people with mild illness were more likely to experience long COVID compared to those who were asymptomatic and those with moderate to severe acute cases.
• Long COVID patients usually have a cluster of related symptoms, rather than just one. Symptoms can last weeks, months, or years. A group of studies out of Europe indicated that symptoms that had persisted for 15 weeks were likely to continue for a year.
• Fewer kids are affected by long COVID than adults, but kids can get it too. They most often report difficulty concentrating and insomnia. Symptoms in kids usually resolve within a few months.
• More women are affected than men. Most long COVID patients of both sexes are middle aged.  People who had underlying health conditions prior to getting COVID are also more likely to experience long COVID.
• Vaccination can prevent long COVID. According to the American Medical Association, patients who are vaccinated are as much as 50 percent less likely to get long COVID. Other studies have come up with similar estimates.
• If you have had COVID (or even if you are not certain you have) and you experience new, ongoing symptoms, or returning symptoms, seek medical attention. While it is tempting to label the condition as long COVID, it may be something else; and doctors will want to rule out the other possibilities. 
• While there are no definitive tests for long COVID, special multidisciplinary clinics, like the one at Dartmouth Health, are working to address long COVID and help patients recover their quality of life. Clinics often include specialists in pulmonology, cardiology, infectious disease, rheumatology, and immunology. In Ireland, doctors are working to create an occupational therapy program to address the needs of long COVID patients.

It is important for everyone to work to avoid getting COVID and long COVID. Get up to date with vaccinations, pay attention to the COVID Community Level in your area, and follow the associated recommendations, including masking in public indoor settings.

Marie George, MD, FIDSA, is an infectious disease physician at SVMC Infectious Disease, part of Southwestern Vermont Medical Center and Southwestern Vermont Health Care in Bennington.